- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,888.44 / $16,982.44
| Facility | | $2,818.38 | $5,888.44 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $14,791.08 / $15,848.93
| Facility | | $11,748.98 | $14,791.08 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,398.83 / $3,019.95
| Professional | | $2,041.74 | $2,398.83 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,801.89 / $5,248.07
| Professional | | $3,019.95 | $3,801.89 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,311.31 / $5,128.61
| Facility | | $2,290.87 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,951.21 / $10,000.00
| Facility | | $1,995.26 | $2,951.21 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |